Keywords

Introduction

Treatment of surgical patients in the ICU, affected by severe illnesses or injuries, should be justified by an acceptable survival and long-term quality of life (QoL). The primary aim of this study was to quantify the long-term QoL (>6 years) of a large cohort of patients admitted to a surgical ICU. In addition, we aimed to explore the influence of different surgical diagnosis groups on long-term health status and to make comparisons with general population norms.

Methods

QoL was measured in all surviving surgical ICU patients admitted to a Dutch teaching hospital between 1995 and 2000. Patient-reported data on QoL were collected with the EuroQol-5D+ after a mean follow up of 8 (range 6 to 11) years. Patient characteristics, surgical diagnosis group, length of ICU stay and survival were prospectively registered. EQ-utility scores (EQ-us), EQ Visual Analogue Scales (EQ-VAS) and prevalences of domain-specific health problems were calculated. The effect of surgical diagnosis group on EQ-us/EQ-VAS was assessed by multivariable generalized linear regression analysis. Logistic regression was used to explore the influence of surgical diagnosis group on domain-specific health problems. Long-term quality of life of surgical ICU patients was compared with an age-matched and sex-matched general Dutch population using the t-test analysis.

Results

Eight hundred and thirty-four patients survived the ICU and were available for follow up. In 598 (72%) patients, the health-related QoL was measured. For all surgical groups combined, after 6 to 11 years nearly one-half of all patients still suffered from problems in the dimensions of mobility (52%), usual activity (52%), pain (57%) and cognition (43%). Compared with the age-matched and sex-matched general Dutch population, HRQoL was worse with a difference of 0.11 on the EQ utilities score (range 0 to 1). Oncological surgery patients had the best (EQ-us 0.83) and vascular patients had the worst (EQ-us 0.72) HRQoL. Trauma (odds ratio between 2.47 and 3.47) and vascular surgery (2.27 to 5.37) showed significantly increased prevalences of problems in mobility, self-care, usual activities and cognition.

Conclusions

More than 6 years after a surgical ICU admission, the QoL of this patient population is largely reduced. Many patients still suffer from a variety of health problems, including decreased cognitive functioning. Treatment advances should be made to reduce the current health deficit of surgical ICU survivors compared with the general population.